MEDICARE: JOSEPH EUGENE WAGNER SWLC, DTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	136A00000X	Registered Dietetic Technician	86170851	MT
2	1041C0700X	Clinical Social Worker	BBH-SWLC-LIC-87652	MT

General Provider Information

NPI Number	:	1588522635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH EUGENE WAGNER SWLC, DTR

Provider Business Mailing Address
First Line	:	830 N WARREN ST
Second Line	:
City	:	HELENA
State	:	MT
Zip	:	59601-3404
Country	:	US
Telephone Number	:	406-315-6686
Fax Number	:

Provider Business Practice Location Address
First Line	:	807 N WASHINGTON ST APT 8
Second Line	:
City	:	HELENA
State	:	MT
Zip	:	59601-3265
Country	:	US
Telephone Number	:	775-223-4786
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2026
Last Update Date	:	01/15/2026

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